Calle Serrano B, Großhennig A, Homs M, Heidrich B, Erhardt A, Deterding K, Jaroszewicz J, Bremer B, Koch A, Cornberg M, Manns M P, Buti M, Wedemeyer H
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infection Research (DZIF), Partner Side HepNet Study-House, Hannover, Germany.
J Viral Hepat. 2014 Nov;21(11):e154-63. doi: 10.1111/jvh.12251. Epub 2014 Mar 27.
Hepatitis delta is considered the most severe form of viral hepatitis, but variables associated with disease progression are poorly defined. This study aimed to identify risk factors associated with worse clinical outcome in patients with hepatitis delta and to develop a clinical score to determine their risk of experiencing liver-related morbidity or mortality. We followed 75 HBsAg-anti-HDV-positive patients with hepatitis delta for up to 16 years (median 5 years). The baseline-event-anticipation score (BEA score) was developed based on variables associated with the development of liver-related clinical complications. Age, region of origin, presence of cirrhosis, albumin, INR, hyperbilirubinemia and thrombocytopenia were all associated with the development of an event in the training cohort. The BEA score included age, sex, region of origin, bilirubin, platelets and INR. Points were allocated according to hazard ratios, and three risk groups were defined: BEA-A mild risk, BEA-B moderate risk and BEA-C high risk. Hazard ratios of BEA-B and BEA-C patients for liver-related clinical endpoints were 9.01 and 25.27 vs BEA-A with an area under curve of the receiving operating characteristic curve of 0.88. The accuracy of the BEA score was confirmed in two independent validation cohorts followed in Barcelona (n = 77) and Düsseldorf (n = 62). Delta hepatitis is associated with a very severe long-term outcome. The BEA score is easy to apply and predicts with a very high accuracy the development of liver-related complications in patients with hepatitis delta.
丁型肝炎被认为是病毒性肝炎最严重的形式，但与疾病进展相关的变量定义尚不明确。本研究旨在确定与丁型肝炎患者临床结局较差相关的危险因素，并制定一个临床评分系统来确定他们发生肝脏相关发病或死亡的风险。我们对75例HBsAg-抗HDV阳性的丁型肝炎患者进行了长达16年的随访（中位时间为5年）。基于与肝脏相关临床并发症发生相关的变量制定了基线事件预期评分（BEA评分）。年龄、原籍地区、肝硬化的存在、白蛋白、国际标准化比值（INR）、高胆红素血症和血小板减少症均与训练队列中事件的发生相关。BEA评分包括年龄、性别、原籍地区、胆红素、血小板和INR。根据风险比分配分数，并定义了三个风险组：BEA-A低风险、BEA-B中度风险和BEA-C高风险。BEA-B和BEA-C患者发生肝脏相关临床终点的风险比分别为9.01和25.27，而BEA-A患者为1，受试者工作特征曲线下面积为0.88。BEA评分的准确性在巴塞罗那（n = 77）和杜塞尔多夫（n = 62）随访的两个独立验证队列中得到了证实。丁型肝炎与非常严重的长期结局相关。BEA评分易于应用，并且能够非常准确地预测丁型肝炎患者肝脏相关并发症的发生。
